Debate On Circumcision Heightened As CDC Evaluates Surgery

[Zeno Swijtink]

Debate On Circumcision Heightened As CDC Evaluates Surgery
ROB STEIN, Staff Writer - Washington Post


Circumcision, long one of the most emotionally charged surgical procedures performed in the United States, has become the focus of yet another intense debate as leading health authorities are about to issue major new evaluations of the potential health benefits of the operation.

The war of words over the procedure has been sparked by a decision by the federal Centers for Disease Control and Prevention to issue recommendations for the first time about whether newborn boys and possibly even adult men should undergo the common surgical procedure, just as the American Academy of Pediatrics is poised to revise its position of not recommending the operation.

The two evaluations, which are nearing completion, come in the wake of new research indicating that the procedure has more health benefits than previously thought, including reducing the risk for getting the AIDS virus and contracting other sexually transmitted diseases.

The rate at which U.S. male newborns are undergoing the procedure has dropped to about 56 percent since peaking at about 80 percent in the 1960s.

The new data on its health benefits have prompted supporters of circumcision to call for greater efforts to encourage the surgery, but opponents liken the operation to genital mutilation and have launched a lobbying campaign to preempt any possible endorsements.

"Circumcision is not an ethical medical procedure," said Georganne Chapin, executive director of Intact America, a Tarrytown, N.Y., advocacy group. "You are removing a perfectly normal body part. We don't allow people to do that to their daughters. We should not let them do it to their sons."

Circumcision, which has been practiced for centuries, involves removing an infant's foreskin. Although long motivated primarily by cultural and religious practices, evidence has been accumulating that it also has health benefits.

In addition to reducing the risk for urinary tract infections among infants, studies indicate that circumcision cuts the chances of adult men's getting penile cancer and becoming infected with a variety of sexually transmitted diseases, including syphilis, AIDS, herpes and the human papillomavirus (HPV), which causes genital warts in men and women and cervical cancer in women.

In 2005, the American Academy of Pediatrics reaffirmed a policy adopted in 1999 that backed away from routinely recommending circumcision, saying the evidence of benefits was insufficient to endorse the routine use of the procedure.

But evidence continued to mount about the possible benefits, most notably three large studies conducted in South Africa, Kenya and Uganda that concluded that circumcised heterosexual men were about half as likely to become infected with HIV as uncircumcised men.

"The evidence has gotten much stronger with the results of these trials of the potential benefits of circumcision," said Ronald H. Gray, a professor of reproductive epidemiology at Johns Hopkins University, who led two of the recent studies.

In addition to reducing the risk for HIV, research indicates circumcision cuts the risk of getting HPV and herpes by about a third, according to a review Gray published last week in the Archives of Pediatric & Adolescent Medicine. Although the procedure does not reduce the risk of HIV infection in the men's female partners, women who had sex with circumcised men were less likely to get HPV and bacterial infections.

"Higher rates of circumcision would certainly prevent a substantial number of infections," Gray said. "The risks are extremely small and the benefits are substantial."
Reduced infection risk

Circumcision appears to reduce the risk for infections because the foreskin contains cells that are more easily penetrated by viruses and has a moister environment more conducive to the growth of viruses and other microbes. The foreskin is also prone to developing tiny tears during sex that increase the risk for infections, Gray said.

"Men who are uncircumcised are more likely to have a variety of infections under the foreskin, and the inflammation from those infections could increase the risk of ulcerations, which could also increase the risk of infection," Gray said.

Other experts agreed.

"If we had a vaccine that was as effective as this at reducing the risk, we'd be jumping up and down with joy," said Arleen A. Leibowitz, a professor of public policy the University of California at Los Angeles.

Leibowitz conducted a study that found that circumcision rates tended to be lower in states where the procedure was not covered by Medicaid; at least 10 state programs stopped covering it in the wake of the academy's position. Medicaid programs in Maryland, Virginia and the District still cover the procedure. She and others hoped an endorsement by the CDC and the academy would prompt more states to cover the surgery.

The academy's 11-member task force met outside Chicago last week to begin finalizing the new position, which will be released later in the year. While noting that recent evidence strengthens the case for circumcision, the task force's chairman refused to indicate what the policy might be.

"It could end up being anything from: It ought to be done on every male; on only some males; or only if the parents want it to be done," said Susan Blank, the assistant commissioner on sexually transmitted diseases at the New York City Department of Health and Human Hygiene. "It could fall anywhere along the spectrum."

Similarly, the CDC plans to release a draft of its first recommendations on the issue by this summer, for both parents of newborns and uncircumcised adult men. Officials stressed that whatever the final recommendations are, they will only serve as guidance and in no way are designed to make the procedure mandatory.

"Given the HIV epidemic in this country, we really need to examine something that is emerging as a new HIV-prevention tool," said Peter Kilmarx, who is coordinating the CDC's look at the issue. "But we're not really just focused just on HIV or STDs [sexually transmitted diseases]. We are looking at safety and cultural concerns and other issues, such as cost-effectiveness. As a public-health agency, we are focused on the public-health aspects of it, but are cognizant of people's broader concerns."
A sign of modernity?

Critics question the relevance of the African studies, saying that most of the HIV transmission in the United States occurs among drug addicts and gay men, whose risk would be unaffected by whether they were circumcised. They also worry that it will give circumcised men a false sense of security. And they say it permanently diminishes the sexual experience.

"Over the history of circumcision, there's been one justification after another. Circumcision was supposed to keep boys from masturbating. Then it was hygiene. Then it became a sign of modernity," Chapin said.

Chapin's group is planning a variety of efforts to discourage the academy from changing its position and to persuade the CDC not to endorse circumcision, including a letter-writing campaign to academy task force members and a petition drive aimed at the CDC.

"We're getting bombarded," said Douglas Diekema, a professor of pediatrics at the University of Washington who is on the task force. "You're talking about a sexual organ, which automatically just by the nature of it gets people pretty upset."

Others charged that the push for circumcision is driven more by economic benefits to doctors than medical benefits to patients and that other methods have been shown to be much more effective, such as antibiotics for urinary tract infections and condoms for sexually transmitted diseases.

"It doesn't have any medical benefit. It's clearly unethical," said Robert Van Howe, a clinical professor of pediatrics and human development at Michigan State University.

Although proponents argue that the evidence that circumcision reduces sexual pleasure remains equivocal and that the risks are low and the benefits clear, others say the risks and benefits have been exaggerated.

"People care way too much about this little piece of skin," said Mark Alanis of the Medical University of South Carolina in Charleston, who has written a history of circumcision. "At the end of the day, it's unlikely to significantly change your child's life for better or worse."

[CSummer]

It is very sad to see the myths of circumcision returning to haunt us. Please understand the true origins of circumcision and what it has become in "modern" times. The practice of genital mutilation, including circumcising, is a ritual practiced by primitive cultures as a way of putting "teeth" into a male's feelings about tribal loyalty. Not only were boys physically marked for life, they were psychologically made to be more emotionally dependent on - and loyal to - their mothers. It is a similar effect to that of mistreated dogs who can show great loyalty toward their abusive owners.

Many "medical" justifications have been made for circumcision, starting with the notion that it was a way to prevent "harmful" masturbation (it never has). With each new generation, it seems a new set of justifications are conjured up while ignoring the harmful effects. Why would "responsible" medical professionals do this? For the money, it seems: The procedure brings in around $1 billion a year for US hospitals and doctors.

What is least known about circumcision is the psychological effect. This is particularly true for "routine infant circumcision." Would you want your son to have post-traumatic stress disorder his whole life? Believe me, it is not only possible; some degree of PTSD is likely to be the result. It is also a violation of basic human rights to needlessly remove a functional, valuable part of a human's body without the person's informed consent.

Please watch the video for information about circumcision from professionals in the field: National Organization of Circumcision Information Resource Centers

If an adult male wants to be circumcised, I would take no issue. Infant circumcision is infant abuse - cruel and unnecessary. Please don't let it happen to your son!

Clint Summer

Debate On Circumcision Heightened As CDC Evaluates Surgery
ROB STEIN, Staff Writer - Washington Post


Circumcision, long one of the most emotionally charged surgical procedures performed in the United States, has become the focus of yet another intense debate as leading health authorities are about to issue major new evaluations of the potential health benefits of the operation.

The war of words over the procedure has been sparked by a decision by the federal Centers for Disease Control and Prevention to issue recommendations for the first time about whether newborn boys and possibly even adult men should undergo the common surgical procedure, just as the American Academy of Pediatrics is poised to revise its position of not recommending the operation.

The two evaluations, which are nearing completion, come in the wake of new research indicating that the procedure has more health benefits than previously thought, including reducing the risk for getting the AIDS virus and contracting other sexually transmitted diseases.

The rate at which U.S. male newborns are undergoing the procedure has dropped to about 56 percent since peaking at about 80 percent in the 1960s.

The new data on its health benefits have prompted supporters of circumcision to call for greater efforts to encourage the surgery, but opponents liken the operation to genital mutilation and have launched a lobbying campaign to preempt any possible endorsements.

"Circumcision is not an ethical medical procedure," said Georganne Chapin, executive director of Intact America, a Tarrytown, N.Y., advocacy group. "You are removing a perfectly normal body part. We don't allow people to do that to their daughters. We should not let them do it to their sons."

Circumcision, which has been practiced for centuries, involves removing an infant's foreskin. Although long motivated primarily by cultural and religious practices, evidence has been accumulating that it also has health benefits.

In addition to reducing the risk for urinary tract infections among infants, studies indicate that circumcision cuts the chances of adult men's getting penile cancer and becoming infected with a variety of sexually transmitted diseases, including syphilis, AIDS, herpes and the human papillomavirus (HPV), which causes genital warts in men and women and cervical cancer in women.

In 2005, the American Academy of Pediatrics reaffirmed a policy adopted in 1999 that backed away from routinely recommending circumcision, saying the evidence of benefits was insufficient to endorse the routine use of the procedure.

But evidence continued to mount about the possible benefits, most notably three large studies conducted in South Africa, Kenya and Uganda that concluded that circumcised heterosexual men were about half as likely to become infected with HIV as uncircumcised men.

"The evidence has gotten much stronger with the results of these trials of the potential benefits of circumcision," said Ronald H. Gray, a professor of reproductive epidemiology at Johns Hopkins University, who led two of the recent studies.

In addition to reducing the risk for HIV, research indicates circumcision cuts the risk of getting HPV and herpes by about a third, according to a review Gray published last week in the Archives of Pediatric & Adolescent Medicine. Although the procedure does not reduce the risk of HIV infection in the men's female partners, women who had sex with circumcised men were less likely to get HPV and bacterial infections.

"Higher rates of circumcision would certainly prevent a substantial number of infections," Gray said. "The risks are extremely small and the benefits are substantial."
Reduced infection risk

Circumcision appears to reduce the risk for infections because the foreskin contains cells that are more easily penetrated by viruses and has a moister environment more conducive to the growth of viruses and other microbes. The foreskin is also prone to developing tiny tears during sex that increase the risk for infections, Gray said.

"Men who are uncircumcised are more likely to have a variety of infections under the foreskin, and the inflammation from those infections could increase the risk of ulcerations, which could also increase the risk of infection," Gray said.

Other experts agreed.

"If we had a vaccine that was as effective as this at reducing the risk, we'd be jumping up and down with joy," said Arleen A. Leibowitz, a professor of public policy the University of California at Los Angeles.

Leibowitz conducted a study that found that circumcision rates tended to be lower in states where the procedure was not covered by Medicaid; at least 10 state programs stopped covering it in the wake of the academy's position. Medicaid programs in Maryland, Virginia and the District still cover the procedure. She and others hoped an endorsement by the CDC and the academy would prompt more states to cover the surgery.

The academy's 11-member task force met outside Chicago last week to begin finalizing the new position, which will be released later in the year. While noting that recent evidence strengthens the case for circumcision, the task force's chairman refused to indicate what the policy might be.

"It could end up being anything from: It ought to be done on every male; on only some males; or only if the parents want it to be done," said Susan Blank, the assistant commissioner on sexually transmitted diseases at the New York City Department of Health and Human Hygiene. "It could fall anywhere along the spectrum."

Similarly, the CDC plans to release a draft of its first recommendations on the issue by this summer, for both parents of newborns and uncircumcised adult men. Officials stressed that whatever the final recommendations are, they will only serve as guidance and in no way are designed to make the procedure mandatory.

"Given the HIV epidemic in this country, we really need to examine something that is emerging as a new HIV-prevention tool," said Peter Kilmarx, who is coordinating the CDC's look at the issue. "But we're not really just focused just on HIV or STDs [sexually transmitted diseases]. We are looking at safety and cultural concerns and other issues, such as cost-effectiveness. As a public-health agency, we are focused on the public-health aspects of it, but are cognizant of people's broader concerns."
A sign of modernity?

Critics question the relevance of the African studies, saying that most of the HIV transmission in the United States occurs among drug addicts and gay men, whose risk would be unaffected by whether they were circumcised. They also worry that it will give circumcised men a false sense of security. And they say it permanently diminishes the sexual experience.

"Over the history of circumcision, there's been one justification after another. Circumcision was supposed to keep boys from masturbating. Then it was hygiene. Then it became a sign of modernity," Chapin said.

Chapin's group is planning a variety of efforts to discourage the academy from changing its position and to persuade the CDC not to endorse circumcision, including a letter-writing campaign to academy task force members and a petition drive aimed at the CDC.

"We're getting bombarded," said Douglas Diekema, a professor of pediatrics at the University of Washington who is on the task force. "You're talking about a sexual organ, which automatically just by the nature of it gets people pretty upset."

Others charged that the push for circumcision is driven more by economic benefits to doctors than medical benefits to patients and that other methods have been shown to be much more effective, such as antibiotics for urinary tract infections and condoms for sexually transmitted diseases.

"It doesn't have any medical benefit. It's clearly unethical," said Robert Van Howe, a clinical professor of pediatrics and human development at Michigan State University.

Although proponents argue that the evidence that circumcision reduces sexual pleasure remains equivocal and that the risks are low and the benefits clear, others say the risks and benefits have been exaggerated.

"People care way too much about this little piece of skin," said Mark Alanis of the Medical University of South Carolina in Charleston, who has written a history of circumcision. "At the end of the day, it's unlikely to significantly change your child's life for better or worse."

[sharingwisdom]

There is an excellent article called "Male Circumcision and the HIV/AID Myth" at https://www.huffingtonpost.com/ali-a-rizvi/male-circumcision-and-the_b_249728.html that discusses this subject in a very different way especially concerning how the data was collected.

Excerpt:
...To be included in the study, men had to be HIV-negative and uncircumcised. The men also had to consent to "avoid sexual contact (except with condom protection) during the 6 weeks following the medicalized circumcision."



The experimental group which underwent the circumcisions was given the following instructions:

"When you are circumcised you will be asked to have no sexual contact in the 6 weeks after surgery. To have sexual contact before your skin of your penis is completely healed, could lead to infection if your partner is infected with a sexually transmitted disease... If you desire to have sexual contact in the 6 weeks after surgery, despite our recommendation, it is absolutely essential that you use a condom."

So the males in the study that underwent circumcision were not only told to abstain from sex for a significant time period after the operation -- reducing their exposure time by six weeks compared to the uncircumcised (control) group -- but told to use condoms, taught how to use them, and educated about their benefits. During this six week period, the men in the uncircumcised group did not have the same restrictions.


There also doesn't seem to be any mention of the researchers calling up the circumcised men after six weeks to say, "Okay, time's up. Ease up on the condom use from here on." The possibility that many of these men might have become accustomed to using condoms, armed with knowledge about their benefits, didn't seem to be much of a concern.

Also, other routes of HIV transmission like blood transfusion, IV needle sharing, or a dentist with dirty instruments (not unimaginable in Africa) don't seem to have been taken into account. Individual variables like hygiene were also poorly controlled for.

Casting further doubt on the theory that circumcision prevents HIV transmission is a simple look at the prevalence of circumcision and the prevalence of HIV/AIDS in different parts of the world.

As a continent, Africa has the highest percentage of circumcised men, over 60%. Africa also has -- as most people know -- the highest prevalence of HIV/AIDS, with South Africa housing the world's largest HIV-infected population. In countries like Nigeria and Kenya, (the latter being one of the countries where the study was conducted) over 80% of males are circumcised, yet they contain the second and fourth largest HIV-infected populations in the world respectively.

Last month, The Lancet -- which refused to publish the male circumcision trials due to certain ethical concerns -- published a study led by Dr. Maria Wawer at the Bloomberg School of Public Health in Baltimore, concluding that circumcising men did not reduce HIV transmission to their female partners.

Actually, it's quite possible that circumcised men are more likely to give their female partners HIV/AIDS than uncircumcised men. Dr. Wawer found that 18% of the women in her study contracted HIV/AIDS from circumcised men, compared to 12% of women who contracted it from uncircumcised.

I did many hours of research before deciding never to circumcize my children, as being raised in a partially Jewish home would have precluded this w/o thinking about it. I'm not very traditional in many ways and I was so grateful to have had 4 home births starting 33 years ago, watching how beautiful and peaceful my babies arrived. To think of circumcizing my two baby boys, having them held down in their first few days, and then cutting off part of their very sensitive penises, without anesthetic, is no less then genital mutilation and torture. And if people think that men don't remember such experiences, I beg to differ as I've spoken to many who have done regressions and remembered. If men are said to not be as sensitive as women, maybe it might start with trauma from such acts of violence and the development of desensitization. I would never consider giving my two daughters clitorectomies.

Two of my children have married or partnered with European men (who are not Jewish or Muslim as this ritual occurs in those groups), and they think, like the vast majority of Europeans, that Americans should examine why people would intentionally do such harm. In fact, my daughter's in-laws are from Belgium and both doctors at Stanford, one in oncology. They never had their son circumcized and find it a ridiculous & barbaric practice. My other son decided to leave his son's penis in tact as nature would have it.

If CDC can talk about the "pandemic" Swine Flu only for it to sizzle out with untested vaccines sitting around, what other false premises for harm can it develop?

Debate On Circumcision Heightened As CDC Evaluates Surgery
ROB STEIN, Staff Writer - Washington Post


Circumcision, long one of the most emotionally charged surgical procedures performed in the United States, has become the focus of yet another intense debate as leading health authorities are about to issue major new evaluations of the potential health benefits of the operation.

...

[Sylph]

I agree with the criticisms of circumcision above. It's pretty ridiculous to think that this is a realistic strategy to combat AIDS in Africa or elsewhere. Many of the points are eloquently expressed here by Dr Edell:
YouTube - AIDS CIRCUMCISION FALLACY
Shame on the CDC!

[Alex]

Extremely well put Clint, that circumcision is variously myth, ritual, conformity, mutilation and abuse are my feelings exactly. I hope more people really take a close second look at this practice. Why not let 18 year olds choose for themselves? I and my 13 year old son have no regrets that I did not have him circumcised.

I couldn't find anywhere in my conscience that gave me the right to remove any perfectly functioning body part of his. I also knew there were millions of lifelong problem free uncircumcised males in the world. But more than anything when thinking about all the fuss, the unanswered challenge to all the justifications for me was.... um, exactly what did nature do wrong??

Thank you for the eloquent summary of the numerous crucial points,
Alex

It is very sad to see the myths of circumcision returning to haunt us. Please understand the true origins of circumcision and what it has become in "modern" times. The practice of genital mutilation, including circumcising, is a ritual practiced by primitive cultures as a way of putting "teeth" into a male's feelings about tribal loyalty. Not only were boys physically marked for life, they were psychologically made to be more emotionally dependent on - and loyal to - their mothers. It is a similar effect to that of mistreated dogs who can show great loyalty toward their abusive owners.

Many "medical" justifications have been made for circumcision, starting with the notion that it was a way to prevent "harmful" masturbation (it never has). With each new generation, it seems a new set of justifications are conjured up while ignoring the harmful effects. Why would "responsible" medical professionals do this? For the money, it seems: The procedure brings in around $1 billion a year for US hospitals and doctors.

What is least known about circumcision is the psychological effect. This is particularly true for "routine infant circumcision." Would you want your son to have post-traumatic stress disorder his whole life? Believe me, it is not only possible; some degree of PTSD is likely to be the result. It is also a violation of basic human rights to needlessly remove a functional, valuable part of a human's body without the person's informed consent.

Please watch the video for information about circumcision from professionals in the field: National Organization of Circumcision Information Resource Centers

If an adult male wants to be circumcised, I would take no issue. Infant circumcision is infant abuse - cruel and unnecessary. Please don't let it happen to your son!

Clint Summer